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Long-Term Efficacy of Prophylactic Cavotricuspid Isthmus Ablation during Atrial Fibrillation Ablation in Patients Without Typical Atrial Flutter: a Prospective, Multicentre, Randomized Trial

Korean Circulation Journal 2021년 51권 1호 p.58 ~ 64
김성환, 오용석, 최영, 황유미, 김주연, 김태석, 김지훈, 장성원, 이만영, 정보영, 최기준,
소속 상세정보
김성환 ( Kim Sung-Hwan ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
오용석 ( Oh Yong-Seog ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
최영 ( Choi Young ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
황유미 ( Hwang You-Mi ) - Catholic University College of Medicine St. Vincent’s Hospital Department of Internal Medicine
김주연 ( Kim Ju-Youn ) - Catholic University College of Medicine Uijeongbu St. Mary’s Hospital Department of Internal Medicine
김태석 ( Kim Tae-Seok ) - Catholic University College of Medicine Daejeon St. Mary’s Hospital Department of Internal Medicine
김지훈 ( Kim Ji-Hoon ) - Catholic University College of Medicine St. Vincent’s Hospital Department of Internal Medicine
장성원 ( Jang Sung-Won ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Internal Medicine
이만영 ( Lee Man-Young ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Internal Medicine
정보영 ( Joung Bo-Young ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Internal Medicine
최기준 ( Choi Kee-Joon ) - University of Ulsan College of Medicine Asan Medical Center Department of Cardiology

Abstract


Background and Objectives: Cavotricuspid isthmus (CTI) block is easily achieved, and prophylactic ablation can be performed during atrial fibrillation (AF) ablation. However, the previous study was too small and short-term to clarify the efficacy of this block.

Methods: Patients who underwent catheter ablation for paroxysmal AF were enrolled, and patients who had previous or induced atrial flutter (AFL) were excluded. We randomly assigned 366 patients to pulmonary vein isolation (PVI) only and prophylactic CTI ablation (PVI vs. PVI+CTI).

Results: There was no significant difference in procedure time between the two groups because most CTI blocks were performed during the waiting time after the PVI (176.8±72.6 minutes in PVI vs. 174.2±76.5 minutes in PVI+CTI, p=0.75). All patients were followed up for at least 18 months, and the median follow-up was 3.4 years. The recurrence rate of AF or AFL was not different in the 2 groups (25.7% in PVI vs. 25.7% in PVI+CTI, p=0.92). The recurrence rate of any AFL was not significantly different in the 2 groups (3.3% in PVI vs. 1.6% in PVI+CTI, p=0.31). The recurrence rate of typical AFL also was not different (0.5% in PVI vs. 0.5% in PVI+CTI, p=0.99).

Conclusions: In this large and long-term follow-up study, prophylactic CTI ablation had no benefit in patients with paroxysmal AF without typical AFL.

키워드

Atrial fibrillation; Atrial flutter; Catheter ablation

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